A Deep Dive Into Psoriatic Arthritis

Dr Joseph Merola kicked off his “PsA 101” session with a clear mission: empower dermatology APPs to better recognize, diagnose, and treat psoriatic arthritis (PsA) before irreversible damage sets in. “Delays in diagnosis are associated with worse outcomes,” Dr Merola emphasized, citing increased risk of erosions, osteolysis, functional disability, and joint deformities.

For many patients, the transition from psoriasis to PsA goes undetected. “Of 285 patients with a diagnosis of PsA, 117 (41%) had not previously been given the diagnosis,” he shared, highlighting how crucial it is for dermatology teams to be vigilant. He introduced a practical screening tool: “It’s as easy as PSA: P—pain in joints, S—stiffness, A—axial pain. If 2 of the 3 are present, formal screening should be completed.”

Dr Merola walked attendees through the hallmark signs of PsA, including enthesitis, dactylitis, and axial symptoms, complete with vivid clinical photos. “Distal interphalangeal erosive changes are common… and joint deformities can occur in 40% to 60% of patients,” he noted. He also addressed common diagnostic pitfalls, helping differentiate PsA from osteoarthritis, rheumatoid arthritis, gout, and fibromyalgia.

Dr Merola provided a sweeping overview of current PsA therapies, from nonsteroidal anti-inflammatory drugs and conventional disease-modifying antirheumatic drugs to biologics targeting IL-17, IL-23, and Janus kinase pathways. “Etanercept doesn’t work well for the eye,” Dr Merola warned, nodding to comorbid inflammatory eye disease. He also presented the 2025 treatment grid and domain-based management strategies now recommended by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology.

Importantly, Dr Merola urged attendees to “approach the whole psoriatic disease patient,” citing the need to assess cardiovascular risk factors and screen for inflammatory bowel disease, inflammatory eye disease, and even sleep disorders. “It takes a team,” he concluded, highlighting the importance of interdisciplinary collaboration across dermatology, rheumatology, ophthalmology, and primary care.

Reference

Merola J. PsA 101. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.